This article will share some key statistics and organizational insights into Norway’s secondary care sector, with particular focus on its hospital and specialist care provision.

As one of the wealthiest countries in the world, Norwegian health expenditures are quite high and topped only by a handful of countries, such as the U.S., Denmark and Switzerland. Norway scores excellently on most healthcare parameters such as health status, infrastructure, access to medical services, and life expectancy (at 81.8 years).

Healthcare expenditure in Norway

Norway’s 10% expenditure on healthcare is especially impressive when one considers that the country has one of the highest GDP values per capita in the world. In absolute terms, the expenditure equals around €35 bn and €6,771 per capita. Considering the expected drop in GDP in the 2016 fiscal year, there will be an overall expenditure reduction on healthcare of €6.4 bn

The state owns all public hospitals, and spending per capita on health and hospital care is almost double that of certain EU nations.

Hospital figures

In total, there are about 62 hospitals in the Norway.

The hospitals are categorized into:

46 public hospitals

8 university hospitals

8 private hospitals

In total there are 13,222 hospital beds, of which 6,796 are public (51%), 291 are private (2.5%) and 6,135 are university (46.5%). This clearly demonstrates that university hospitals have a crucial presence in Norwegian healthcare, whereas private hospitals only meet a fraction of the healthcare demands, although both have the same count of hospitals in the market.

The average length of stay in an acute hospital is around 4.1 days (one of the lowest in Europe) and the overall hospital occupancy rate is 87.7% (amongst the highest in Europe).

Organization of hospitals and secondary care

Secondary care is mainly provided through Norway’s Regional Health Authorities (RHAs). They own and operate the country’s hospital trusts.

RHAs also engage in contractual agreements with privately owned for-profit hospitals, which provide a wide array of both in-patient and ambulatory care services. However, private hospitals do not provide acute care, and are principally focused on specialized elective procedures.

Outpatient care is also provided through hospital outpatient departments called polyclinics, whose services include: somatic care, some mental care services, and substance abuse treatment. Polyclinics are usually equipped to provide both laboratory and radiology services.

The secondary care system also plays a role in supporting the primary sector. GPs will often consult a hospital-based specialist on how to proceed for a particular patient, or how to follow up on treatment.

Some private sector specialists practice on a self-employed level in their own practices and have contracts with the regional health authorities (RHA) to lend public provisions.

Secondary care in Norway also encompasses a wide network of mobile specialists that are trained and equipped to take part in community care activities (e.g. for geriatric patients or cancer patients that are bedridden and home bound).

Under the Norwegian healthcare system, certain medical services that are considered to be of high complexity have been deemed national care services and they include procedures such as heart transplants and specialized care for patients with hemophilia. These services tend to be offered at specialized university hospitals and each region has at least one of these hospitals in their larger cities. In total, about 30 care services are categorized as national services.

Centralization of complex procedures

Recent years have seen a concentration of more complex procedures being performed in higher-level and lesser hospitals, as a means to improve the expertise in fewer yet more qualified and better-equipped locations, and to boost patient outcomes overall. This has also led to a reduction of hospital specialisms in certain hospitals, and even the closure of others. This has not always been optimal for patient-accessibility, in a country with large sparsely populated areas such as Norway.

Recruitment of surgical specialists for rural hospitals is also a challenge.

Since 2008, there has been a long-term plan to merge several smaller hospitals to create newer hospitals to serve as replacements in 7 catchment areas. So far, 3 newer larger hospitals have opened, and 2 smaller local ones were eliminated.

Example of specialism centralization: coronary angioplasty

Ambulances picking up a critical patient have the capacity to take an ECG scan and send this to a cardiologist, who can evaluate whether the patient requires specialized surgery, based on extent of artery blockage.

Per ambulance, or helicopter, the patient is then transported to 1 of 4 centers throughout Norway, that have the most optimal experience and facilities for this condition.

Hospital priorities

Priorities and areas of focus for Norwegian hospitals, currently and in the near future, are:

Streamlining communication with municipalities and the primary care sector

Improving care pathways

Shortening waiting times for specialist care

Decreasing the rate of re-admissions

Improving the overall quality of care

Strengthening the usage of information technology systems

Shifting the focus from inpatient care to outpatient settings and to day-care surgery